PAULO MANUEL PEGO FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina - Líder
37 resultados
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- A New 3D CT Method to Analyze Bronchial Stenosis after Lung Transplantation(2019) DIAS, Y. T. Nunes; CHATE, R. C.; NOGUEIRA FILHO, J. M.; CIRILLO, G. G.; PEGO-FERNANDES, P. M.; SAMANO, M. N.
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed?(2015) FONESCA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.Background. Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation. Methods. We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected. Results. Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes. Conclusions. Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed? (vol 47, pg 1029, 2015)(2015) FONSECA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.
- Ex-Vivo Lung Perfusion for Infected Non-Acceptable Donor Lungs: A Pilot Study(2014) SAMANO, M. N.; ABDALLA, L. G.; FERNANDES, L. M.; NEPOMUCENO, N. A.; BRAGA, K. A. Oliveira; AZEVEDO-PEREIRA, A. E.; PEGO-FERNANDES, P. M.
conferenceObject Management of Tuberculosis After Lung Transplantation in na Endemic Region(2017) CAMPOS, S. V.; SAMANO, M. N.; PEGO-FERNANDES, P. M.; TEIXEIRA, R. O.; FERNANDES, L. M.; ABDALLA, L. G.; CARRARO, R. M.; AFONSO-JUNIOR, J. E.; COSTA, A. N.- Comparison of Bronchial Anastomotic Techniques in Lung Transplantation by 3D CT Analysis(2019) CIRILLO, G. G.; CHATE, R. C.; NOGUEIRA FILHO, J. M.; DIAS, Y. N.; PEGO-FERNANDES, P. M.; SAMANO, M. N.
- Study of Burkholderia Cepacia Complex Strains in Lung Transplant Patients: Analysis of Genomovar and Mortality Impact(2014) CARRARO, D. S.; CAMPOS, S. V.; OLIVEIRA-BRAGA, K. A.; IUAMOTO, L. R.; CARRARO, R. M.; OLIVEIRA, L. C.; ROSSI, F.; SABINO, E. C.; PEGO-FERNANDES, P. M.
- Posterior Reversible Encephalopathy Syndrome in Lung Transplantation: 5 Case Reports(2014) ARIMURA, F. E.; CAMARGO, P. C. L. B.; COSTA, A. N.; TEIXEIRA, R. H. O. B.; CARRARO, R. M.; AFONSO JR., J. E.; CAMPOS, S. V.; SAMANO, M. N.; FERNANDES, L. M.; ABDALLA, L. G.; PEGO-FERNANDES, P. M.Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiologic entity characterized by typical neurologic symptoms with characteristic cerebral image alterations. It has been reported in solid organ transplantations, especially related to the use of calcineurin inhibitors. The incidence of PRES in lung transplantation is unknown and probably under-reported in the literature. Here we describe 5 cases of PRES after bilateral lung transplantation. One of the reported cases was the first in the literature in which the neurologic onset precluded the introduction of calcineurin inhibitor. Therefore, although calcineurin inhibitors are known to play an important role in the development of PRES in the setting of lung transplantation, other causes seems to be involved in the physiopathology of this syndrome.
- Effects of Prednisone on Mucociliary Clearance in a Murine Model(2012) OLIVEIRA-BRAGA, K. A.; NEPOMUCENO, N. A.; CORREIA, A. T.; JATENE, F. B.; PEGO-FERNANDES, P. M.All transplant patients are at increased risk of developing pulmonary infections, a significant cause of morbidity and mortality. Immunosuppressants increase the incidence of lung infection by acting not only directly on the inflammatory cells, but also on the native immune system. Experimental studies have shown corticosteroid therapy, which is used in most immunosuppressive protocols after transplantation, to suppress mucus production by inhibiting calceiform. The objective of this study was to evaluate the effects of prednisone on mucociliary clearance. A total of 120 male Wistar rats were distributed into 4 groups. Animals in P1, P2, and P3 groups received daily doses of prednisone (0.625, 1.25, and 2.5 mg/kg/d), and hosts in the Sal group underwent gavage with saline solution (2.5 mL/d). After 7, 15, and 30 days, treatment, animals were killed. We assessed ciliary beating frequency (CBF), mucociliary transport velocity (MCTV), and mucus transportability (MT). There was no significant difference for CBF regarding dose (P = .089) or treatment duration (P = .175). MCTV values of 0.60 +/- 0.14 in group P1, 0.59 +/- 0.13 in group P2, 0.51 +/- 0.19 in group P3, and 0.61 +/- 0.08 Group Sal, showed P3 to significantly differ from P1 (P = .048) and Sal (P = .007) groups. Regardless of the prednisone dose, all groups displayed impaired MT compared with the Sal group: P1 (P = .02); P2 (P = .02) P3 (P = .03). There was no interaction between the therapy and the treatment time for CBF (P = .10), MCTV (P = .71), and MT (P = .64). Prednisone reduced the transportability of mucus even when administered at low doses; however, this change was not sufficient to alter the mucociliary clearance. Only high doses of prednisone impaired mucociliary clearance.
- Effect of methylprednisolone on perivascular pulmonary edema, inflammatory infiltrate, VEGF and TGF-beta immunoexpression in the remaining lungs of rats after left pneumonectomy(2011) GUIMARAES-FERNANDES, F.; SAMANO, M. N.; VIEIRA, R. P.; CARVALHO, C. R.; PAZETTI, R.; MOREIRA, L. F. P.; PEGO-FERNANDES, P. M.; JATENE, F. B.Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO(2)/FiO(2) ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-beta) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO(2)/FiO(2) ratio, neutrophil density or TGF-beta expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-beta expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.